Preoperative staging of cervical cancer: Is 18-FDG-PET/CT really effective in patients with early stage disease?
Highlights
► Prospective evaluation of PET/CT in lymph node staging in early stage Ib1–IIa cervical cancer. ► Low sensitivity and accuracy. ► PET/CT scan has a limited benefit as pretreatment imaging technique.
Introduction
Uterine cervical carcinoma is the second most common cancer diagnosed in women worldwide [1].
Early stage disease can either be treated with radical hysterectomy, pelvic lymphadenectomy or postsurgical adjuvant therapies according to risk factors or definitive radiotherapy, with comparable cure rates [2].
Lymph node status is one of the most powerful prognostic factors in determining the administration of adjuvant therapies in surgically treated patients, and influencing survival rate of patients with early-stage cervical cancer [2], [3], [4], [5], [6], [7], [8].
The identification of pelvic and aortic nodal metastases has a fundamental role in clinical management of cervical cancer patients, as it guides physicians in choosing the most appropriated treatment strategy. 18F-FDG-PET/CT scanners, which combine functional information from positron emission tomography (PET) with anatomical information from computed tomography (CT), have been evaluated over the last years as an innovative non invasive procedure in the pretreatment staging and in defining response to primary therapy or during follow up in gynecologic cancers [9], [10], [11], [12]. In cervical cancer, 18F-FDG-PET and 18F-FDG-PET/CT have been studied to evaluate the response and to diagnose the local recurrence of the disease after chemoradiation therapy, or to detect pelvic and aortic nodal metastases, especially in locally advanced cancer, in order to better define the radiation field [11], [13], [14], [15], [16], [17].
The purpose of this prospective study was to define the role of 18F-FDG-PET/CT in pelvic nodal assessment in a large series of patients with early stage cervical cancer treated in the same institution.
Section snippets
Population and study design
Patients with histologically proven (biopsy or conization) stage Ib1–IIa < 4 cm cervical carcinoma were evaluated for this study. All consecutive patients who met the stage inclusion criteria, underwent 18F-FDG PET/CT imaging at San Raffaele Hospital (HSR), Milan between January 2004 and December 2005 and at San Gerardo Hospital (HSG), Monza, Italy from January 2006 to December 2010. All patients suitable for a surgical treatment underwent surgery at the gynecologic oncology department of San
Patient characteristics and histopathologic findings
From January 2004 to December 2010, twenty-nine women with stage Ib1–IIa < 4 cm diameter cervical cancer treated in our institution did not undergo surgical treatment and were treated with external beam radiotherapy plus brachytherapy with or without concomitant chemotherapy, and were excluded from the analysis. In particular, 16 of these women underwent 18F-FDG-PET/CT which suggested the presence of pelvic node metastasis in 4 patients (25%).
Nineteen women were furthermore excluded because they
Discussion
Cervical cancer treatment is determined by FIGO stage of the disease. Locally advanced stage tumors (IB2-IVA) are usually treated with chemoradiation or, in some countries, with radical surgery after a neoadjuvant chemotherapy, while treatment of early stage IA2-IIA (< 4 cm) disease is based on surgery, including radical hysterectomy and pelvic lymphadenectomy, with adjuvant therapies in presence of pathologic risk factors, or definitive radiotherapy with or without concomitant chemotherapy [2],
Conflict of interest statement
The authors declare that there are no conflicts of interest.
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2021, Gynecologic OncologyCitation Excerpt :Previous studies on the accuracy of FDG-PET/CT show wide-ranged sensitivities of 0–68.0% in women with early-stage cervical cancer [29,33,34]. Two studies performed stratified analyses on women with tumors >20 mm; one prospective study presented a sensitivity of 35.0% in 62 women, while Papadia et al. show a sensitivity of 68.0% in 41 women. [29,34]. Papadia et al. retrospectively investigated the use of FDG-PET/CT in combination with SLN mapping and interestingly showed a higher sensitivity than ours.
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